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Dry Needling (Precautions of DN (Areas to be careful of: (• Needling near…

- - - - Needling may strengthen soft tissues such as tendons and ligaments by inducing a local inflammatory response. Fenestrations of areas of tendinosis and ligament insufficiency by needling may promote beneficial bleeding into new channels created through degenerated mucoid tissues.
      - It must be noted that the healing process can be delayed or weakened if the blood supply is poor, if the patient is poorly nourished (particularly in the presence of ascorbic and zinc deficiency) and if the patient is being treated simultaneously with anti-inflammatory medications. Smoking can also affect healing.
    - - The rotation of a needle in hypertonic muscle tissue can tug on muscle fibers, similar to the way thread roll on a spool. This action seems to stimulate stretch-sensitive Golgi receptors and muscle spindles, which may account for the resulting muscle relaxation. The secondary muscle spindles which provided static load information have been implicated with the propagated needle sensation of acupuncture and dry needling.
    - - Insertional electrical activity occurs from the depolarization of innervated single or group muscle fiber discharges which are micro-twitches.
      - Travell has reported that active myofascial trigger points can be treated with dry needling since it often leads to characteristic muscle twitches and stretch effects on the adjacent shortened muscle fibers. The resulting muscle relaxation may reduce mechanical stresses on tissues such as intramuscular nerves, blood vessels, and tendons, thereby allowing more effective healing (Gunn ibid, Chu ibid)
      - "The needle may mechanically disrupt abnormally functioning contractile elements or nerve endings which are sensor and motor components of the feedback loop believed responsible for sustaining the trigger point activity. Cessation of the neuromuscular dysfunction relieves the tautness of the palpable band of muscle fibers and the hyperirritability of the sensory nerve that is responsible for both the referred phenomena and local tenderness." Travell and Simons (1983)
    - - Chronic muscle tension and spasm can cause reduced oxygen and other nutrient supply. This in turn, can possibly result in a small area of abnormal function and ectopic muscle facilitation. Bleeding, which can be an effect of needling, can break microscars in these areas and can provide blood and growth factors to facilitate healing. Platelet-derived growth factor can attract cells and facilitate DNA synthesis as well as stimulate collagen and protein formation. Growth factors may heal localized tissues as well as sensitized nerves. This process may lead to the healing of somatic as well as visceral tissues (Gunn ibid).
    - - Needling may alter neural control by neurotransmitter and endorphin stimulation. Needling can activate reflexes that stimulate inhibitory fibers by a fusimotor mechanism and may result in transmission saturation or depletion in joint and other receptors. Travell and Simons (ibid) also state that the local release of intracellular potassium due to damage to muscle fibers by the needles can cause a depolarization block of nerve fibers in the area where extracellular potassium reached significant concentrations.
      - Needling cutaneous and other tissues can stimulate various spinal reflexes and serotinergic descending inhibitory systems. Pain fibers (somatic nociceptors) travel to the dorsal root ganglia and are distributed to specific segmental levels in the spinal cord. They also communicate with the afferent sympathetic neurons of the viscera and blood vessels that travel to the same cord segment (Wall ibid). This may potentially account for various segmental as well as sympathetic effects seen with needling techniques.
      - Periosteal needling techniques (Lawrence 1987) are believed to regulate sympathetic fibers in and around the periosteum, increasing blood circulation to the area.
  - - - In an article by Carlsson (2002), he suggested the following mechanisms:
        
        Peripheral events that might improve tissue healing and give rise to local pain relief through axon reflexes, the release of neuropeptides with trophic effects, dichotomising nerve fibres and local endorphins.
        
        Spinal mechanisms, for example, gate-control, long-term depression, propriospinal inhibition and the balance between long-term depression and long-term potentiation.
        
        Supraspinal mechanisms through the descending pain inhibitory system, DNIC, the sympathetic nervous system and the HPA-axis. Is oxytocin also involved in the long-term effects?
        
        Cortical, psychological, "placebo" mechanisms from counselling, reassurance and anxiety reduction.